Remote Pharmacy Network Relations Specialist

Navitus Health Solutions; United States; On-site; USD 49,000 - 58,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Paid time off

Parental leave

Holidays

401K match

Adoption assistance

Flexible Spending Account

Education assistance

Professional memberships

Referral bonus

Job summary

Navitus Health Solutions is seeking a Pharmacy Relations Specialist (PRS II) to manage contracting with pharmacies, respond to inquiries, and maintain contracted networks. The role focuses on network design, compliance, and claims processing, with opportunities to support audits and client communications.

The candidate should have 2+ years in pharmacy or related roles, a technical degree or equivalent experience, and strong Microsoft Office skills.

Qualifications

• College or 2-year Technical Degree or equivalent experience preferred.
• Certified Pharmacy Technician preferred.
• 3 years business-setting experience.
• Retail pharmacy or managed care setting experience desired.
• Experience analyzing medical and/or pharmacy claims or credentials desired.
• Proficient in Microsoft Office and industry related software.
• Ability to interact cooperatively and respectfully with others.

Responsibilities

• Manage pharmacy contracting with independent pharmacies and select chains/PSAOs and assist management with network negotiations; inclusive of redline reviews.
• Review pharmacy contract setup to ensure compliance with pharmacy network agreements.
• Support pharmacy audits and network compliance initiatives.
• Research and problem solve to resolve claim issues and concerns.
• Respond to and track requests, inquiries, and communications with network pharmacies.
• Develop, review, and distribute pharmacy communications to meet internal and client requests.
• Monitor, track, and report pharmacy compliance with guiding government regulations and internal policies and procedures.
• Reviews and responds to independent pharmacy redlines; with little to no input from senior leadership.
• Responsible for all aspects of maintenance related to pharmacy network functions, such as, network plan design builds, quality assurance measures and claims processing in general.
• Other duties as assigned.

Skills

Pharmacy knowledge

Microsoft Office

Interpersonal skills

Contract management

Claims analysis

Education

College or 2-year Technical Degree or equivalent experience

Certified Pharmacy Technician

Tools

Microsoft Office

Job description

Navitus Health Solutions is seeking a Pharmacy Relations Specialist (PRS II) to manage contracting with pharmacies, respond to inquiries, and maintain contracted networks. The role focuses on network design, compliance, and claims processing, with opportunities to support audits and client communications.

The candidate should have 2+ years in pharmacy or related roles, a technical degree or equivalent experience, and strong Microsoft Office skills.